the effectiveness of natural virgin coconut oil in

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Annals of R.S.C.B., ISSN: 1583-6258, Vol. 25, Issue 6, 2021, Pages. 4364 – 4375

Received 25 April 2021; Accepted 08 May 2021.

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The Effectiveness of Natural Virgin Coconut Oil in Periodontal Tissue

Regeneration

Hasanuddin Thahir1, Sri Oktawati

1, Harun Ahmad

2, Rasmidar Samad

3, Ayu Rahayu Feblina

4,

Afdalia Annisa4, Nir Etriyani

4,

1Lecturer of Periodontology Department, Faculty of Dentistry, Hasanuddin University, Indonesia 2Lecturer of Pediatric Dentistry Department, Faculty of Dentistry, Hasanuddin University, Indonesia

3Lecturer of Public Dental Health Department, Faculty of Dentistry, Hasanuddin University, Indonesia 4Periodontolgy Specialist Educational Program of Dentistry Faculty, Hasanuddin University,

Indonesia Corresponding Author: [email protected]

ABSTRACT

Background: Periodontal disease is the most common inflammatory disease presents in humans. Data

from Global Burden of Disease in 1990-2010 shows that periodontal disease, particularly periodontitis, ranks sixth globally with percentage of 11.2% and suffered by approximately 743 million people. While

in Indonesia according to the data from RISKESDAS 2018, the prevalence of periodontitis reached 74.1%

of the total number of oral diseases experienced by the population. Coconut plant (Cocosnucifera L) has

great potential to be processed into useful products. Virgin Coconut Oil (VCO) formed by processing coconut flesh into oil is used as medicine and believed to cure various diseases. The advantage of this oil

lies in the high level of saturated fatty acids (around 90%), which makes VCO the healthiest oil. VCO is

very rich in lauric acid content, ranging 50-70%, which gives VCO a tissue regeneration effect. Objective: This study aims to discuss the effectiveness of VCO on the regeneration of periodontal soft

tissue in periodontitis. Method: A systematic study was conducted on the PubMed and Google Scholar

databases for clinical trials published in English up until 2021. A preliminary search of the databases resulted in 110 articles. Manual searches of full text articles and other related articles were carried out

afterwards. PICO (Population, Intervention, Control, and Outcomes) questions were used in this

systematic review. The articles selected were those that focused on the effectiveness of VCO on tissue

healing and regeneration. Literature Review: Virgin Coconut Oil is proven to speed up wound healing time and has the highest healing rate, due to its ability to moisturize wounds, accelerate cellular

metabolism, and has the anti-inflammatory and anti-infection properties in treating chemical burns. VCO

with its high lauric acid content can accelerate the tissue regeneration process, where regeneration is often used to describe the formation of new adhesions, cementum, alveolar bone and periodontal ligaments on

the site that has previously lost the tooth-supporting tissue structure. Regeneration will result in the

replacement of the damaged tissue with the same newly-formed tissue.

Conclusion: Is proven to provide many benefits for daily life, especially in the health sector. Lauric acid, which is abundant in VCO, can stimulate soft tissue that is damaged due to inflammation, also accelerates

wound and tissue healing.

Keyword: Virgin Coconut Oil, Regenerative Therapy, Periodontitis

INTRODUCTION

Periodontitis is one of the most common diseases in Indonesia, based on the results of the 2018

Ministry of Health’s RISKESDAS study, the prevalence of periodontitis reached 74.1%

(Ministry of Health 2018). Periodontitis is a periodontal disease characterized by inflammation

of the tissues supporting the teeth. Periodontitis progression is generally caused by plaque

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bacteria on the tooth surface, where plaque is a thin layer of biofilm containing a cluster of

pathogenic microorganisms.(1,2) Periodontitis if not handled properly, then the interaction

between plaque bacteria, their products and the body’s response can trigger an inflammatory

response that can cause ulceration of the gingiva, damage on connective tissue, loss of alveolar

bone, and eventually tooth loss.(3)

As a country with tropical climate, Indonesia is able to produce roughly 183 tons of coconuts

each year. Virgin Coconut Oil (VCO) is a popular coconut product that possesses many benefits,

made from fresh coconut meat, processed at low temperature to produce a product with low

content of water and free fatty acids, is transparent, fragrant, and has a long shelf life of up to 12

months.(4,5) VCO contains lauric acid and caprylic acid (6-7%) which have the ability to kill

bacteria and viruses. Lauric acid in VCO is converted into mono laurin which has antiviral,

antibacterial and antiprotozoal properties.(6) Lauric acid in VCO also has the effect of stimulating

fibroblast cells by fibronectin. Lauric acid is associated with the activation of transforming

growth factor beta (TGF-β), which is a proliferating growth factor that stimulates fibronectin in

the formation of fibrin threads and clots. In a research conducted by Jannahet al., The Effect of

Virgin Coconut Oil Application on Increasing the Number of Fibroblasts in Post Tooth

Extraction Wounds in Rattusnovergicus, showed an increase in the number of fibroblasts in

wounds after tooth extraction performed in Rattusnovergicus, in which the wound was treated

with oral VCO, and VCO was able to increase fibroblasts 0.4 times greater than povidone

iodine.(5)

METHOD

DATA SOURCE

Data search using Google Scholar and Pubmed with English keyword was carried out to

determine the research protocol. The search was done to identify articles published in dental

journals that focused on VCO and soft tissue therapy. The keywords used were VCO,

Periodontitis, and Tissue Regeneration. Search filters were applied to the electronic search to

display only English studies that provide full-text articles. Manual searches of published full-text

articles and related literature reviews were carried out afterwards.





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The inclusion criteria used for this review are English full-text articles published between 2016-

2021 and are related to the effect of VCO on periodontal soft tissue regeneration. Meanwhile, the

exclusion criteria were articles in the form of systematic reviews, blogs, textbooks, and meta-

analysis.

DATA COLLECTION

The data used in this literature review are secondary data. The data were obtained from articles

which were then reviewed based on the criteria determined by the authors.

RESULT

After 110 articles were gathered from Google Scholar and Pubmed searches, 66 articles were

excluded because they did not meet the criteria desired by the authors, leaving 36 articles that

were then reviewed based on their titles and abstracts, after which 27 articles were excluded

because they did not match the inclusion criteria. Finally, 9 articles were obtained, reviewed and

then entered into the synthesis table.

Articles agreed for inclusion

in the review

incl ude d

Full-text articles excluded,

with reasons (n=37)

Records excluded (n=66)

Records screened by titles

and abstracts (n=27) scre eni ng

Identificati on Records identified through database

searching (PubMed) (n= 2)

Additional records identified through

other sources (Google Cochrane)

(n=108)

eligi bilit y Full-text articles assessed

for eligibility (n=9)





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Table1. Effect of VCO gel application on periodontal soft tissue regeneration

No Journal reference Method Result

1 Francesca Ripari (2020)

The Role of Coconut Oil in

Treating Patients Affected by

Plaque-Induced Gingivitis: A Pilot Study.(7)

Materials and Methods The sample

of 20 patients was divided into two

groups: the study group and the

control group. In the study group,

coconut oil, in the form of

mouthwash, was administered to a

sample of patients with gingivitis,

aged between 18

and 35. The protocol established a daily application of the product for

30 days, in which the clinical

parameters for plaque formation and

gingivitis were measured by the

plaque index ( PI), bleeding index

(BI). The control group did not

associate the coadjutant with normal

daily oral hygiene procedures and

the sa me clinical parameters were

evaluated at t0 and after 30 days (t1).

Based on the data collected

showed a significant

improvement in reducing plaque

formation and gingivitis

2 Sandeep R. Varma (2017)

In vitro anti-

inflammatory and skin

protective properties of Virgin

coconut toil.(7)

Cell lines and its maintenance,

chemicals, gas chromatography-FID analysis, cell viability, ELISA for

cytokine measurement, ELISA for

involucrin and filaggrin, semi-

quantitative RT-PCR, skin irritation

and phototoxicity assay, UV

inhibitory study by reactive oxygen

species assay.

The study shows the anti-

inflammatory activity of VCO that suppresses inflammatory markers and

protects the skin by enhance in the

skin’s protective function.

3 Ratna sari dewi. atall (2017)

Effect of 12.5% virgin coconut

oil on porphyromonas

gingivalis and trepoema

dentico labacterialcolonization .(8)

23 subjects, were patients with

posterior porcelain-fused-to-metal

crown visiting Faculty of Dentistry University Indonesia dental hospital.

Patients signed the informed consent

and clinical periodontal examination

was done Patients were asked to

gargle twice daily with

12.5%virgincoconutoil, 30cc for 1

min in 4days. Saliva samples were

collected with paper point to

calculate the number of P. gingivalis

and T. denticola using real- time

polymerase chain reaction on.

The use of 12.5% virgin coconut oil

showed a decrease in the number of

P. gingivalis and T. denticolaon the margin of the porcelain-fused- to-

metal crown.





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4 Ummi Aqilah

Haron.atall

(2017)

The Comparative

Antimicrobial Effect

of Activated Virgin

Coconut Oil (AVCO)

and Virgin Coconut

Oil (VCO) against

Dental Caries-

Related Pathogens.(9)

In this study, the researchers

compared the antimicrobial effect of

AVCO obtained from KL trading,

Selangor, Malaysia, and VCO

extracted in their own laboratory. The MIC and MBC of each coconut oil

against the selected dental caries-

related pathogen; Streptococcus

mutans, Lactobacillus casei and

Candida albicans were determined.

In contrast to a positive finding of AVCO,

VCO has shown no inhibitory effect on all

tested dental caries-related pathogens.

Furthermore, the time killing as say

revealed that AVCO showed relatively quick-killing activity at the 8 hours of time

for all tested organism.

These finding correlates with that of AVCO

possess bactericidal activity, there by

allowing the possible classification of the

AVCO as being a bactericidal agent.

5 PRIMA

ABIGAIL

Gayatri (2019)

Stability Of Zoledronate Gel Emulsion In Virgin Coconut

Oil.(11)

ZOL gel emulsion consists of 0.16%

ZOL powder, 2% carboxymethyl

cellulose, 5% VCO, 0.44% sodium

benzoate, and 0.009% antioxidant hydroxytoluene, and distilled water.

This gel emulsion sample was stored a t

25 ° C and 40 ° C for 1 month, and the

parameters used for the stability test

were pH, viscosity, spread ability, and

adhesive strength. ZOL gel emulsion

was evaluated against this metric on

days 1, 7, 14, and 28.

This study found that the ZOL gel

emulsion was stable when stored at 25 °

C. Organoleptic values, pH, viscosity,

dispensability, and adhesive strength were also stable, and degradation was

constant.

6 Siti

Fatimah

BintiRah

mat(2018)

Virgin Coconut

Oil, Coconut Milk And Coconut

Water Potential In

the

Remineralization

Of Tooth Enamel

Surface.(12)

The research was started by analyz in

the elemental content of VCO, CM,

and CW using ICP-MS.

Following the evaluation no f enamel

remineralization, the specimens were

observed under a Scanning electron

microscope. The specimens were

demineralized using a demineralization

solution at p H 4.01 for 7 days then reacted with VCO, CM, and CW as

remineralization solutions for 14 days.

Distilled water was used as a control

during the study. Observations using SEM / EDX.

In general, this study aims to determine the

potential of virgin coconut oil (VCO),

coconut milk (CM), and coconut water

(CW) as new alternatives in remineralizing

the surface of tooth enamel.

The results showed that VCO and CM left a

protective layer over the enamel surface,

while the control did not show any changes

in the enamel surface morphology.

7 Putri Dafriani, et all

(2020)

Virgin Coconut Oil

(VCO) Accelerated

Wound Healing

Process in Diabetes

mellitus (DM)

Patients With

Diabetic Ulcer in dr.

Rasidin Hospital,

Padang, Indonesia.(12)

This research is a quasi- experimental

research carried out in the Inpatient

Installation of Dr. Rasidin Hospital

Padang, West Sumatera, Indonesia.

The study participants were diabetic

ulcer patients who were divided into 2

groups, 8 patients in the control group

and 8 patients in the intervention group. The control group was given

wound care using 0.9% NaCl and the

intervention group was treated with

0.9% NaCl plus VCO.

There were significant differences in the

wound surface between the control group and

the intervention group. VCO helps wound

healing by reducing the surface area of the

wound.





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8 Jansen Silalahi, et al (2019)

The Activity of

Hydrolyzed Virgin

Coconut Oil to

Increase

Proliferation and Cyclooxygenase-2

Expression towards

on NIH 3T3 Cell

Line in Wound

Healing Process.(13)

The sample used was Virgin Coconut

Oil (VCO). VCO was partially

hydrolyzed using lipase from

Rhizomucormiehei to produce hydrolyzed VCO (HVCO)

Composed of free fatty acids, 2-

monoglycerides.

Then acid value was determined. The

effect of HVCO on proliferation was

evaluate d using the MTT method.

Wound healing as say was esta blished

by a cell migration method, and COX-

2 Expression was determined using RT-

PCR.

HVCO is proven to be effective in

increasing cell proliferation and wound

healing process. The activity of Hydrolyzed

Virgin Coconut Oil increases the proliferation and expression of

Cyclooxygenase-2 against the NIH 3T3 cell

line in the wound healing process.

9 Dian Ika Perbina

Meliala, et all (2019)

The Role of Coconut

Oil to Increase

Expression of MMP- 9,

PDGF-BB, and TGF-

β1 in NIH-3T3 Cell

Line.(14)

Coconut oil used in this study was

virgin coconut oil (VCO) and VCO

Hydrolyzed by Rhizomucormiehei

(HVCO). NIH 3T3 cells (5x105cells/well) were seeded in

nine well sand incubated for overnight,

then divided into three groups

Each group consisted of three wells.

Group one without treatment, group

two added VCO, and group three

added HVCO

And then incubated for overnight. One

well in each group was added MMP- 9,

PDGF-BB, and TGF-β1

And incubated one hour. Finally, expressions of MMP-9, PDGF-BB,

and TGF-β1 were detected using immune cytoc hemistry method.

VCO and HVCO increase the expression

of MMP-9, PDGF-BB, dan TGF-β1 in

NIH3T3.

Cells and therefore, coconut oil active in t he wound healing

process. HVCO is more than

active than VCO.


https://pubmed.ncbi.nlm.nih.gov/?term=Silalahi%2BJ&cauthor_id=31949510

https://pubmed.ncbi.nlm.nih.gov/?term=Meliala%2BDIP&cauthor_id=32127964

https://pubmed.ncbi.nlm.nih.gov/?term=Meliala%2BDIP&cauthor_id=32127964




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LITERATURE REVIEW

Periodontitis

Periodontitis is defined as an inflammatory disease of the tooth-supporting tissue, caused by

certain microorganisms where these organisms produce a number virulence factors and induce

host inflammatory mediators, causing inflammation that extends into the tissue and potentially

resulting in progressive damage to the periodontal ligament and alveolar bone with increased

probing depth, recession, or both, causing mobility and eventually tooth loss. The severity varies

between individuals, regardless of the degree of bacterial infection, suggesting that a regulated

host inflammatory response may contribute to the presence of microorganisms.(16–18)

Etiology of Periodontitis

The etiology of periodontitis comes from a group of bacteria, especially gram-negative and

anaerobic bacteria, which colonizes the sub-gingival region. Specific bacteria such as

Porphyromona sgingivalis, Tannerelaforsythia, Treponemadenticola, Aggregatibacteri

actinomycetemcomitans, Prevotellaintermedia, Fusucobacteriumnucleatum, which to this day is

termed “Red complex” bacteria (P. gingivalis, Tannerellaforsythia, Treponemadenticola) are the

primary etiological factor in periodontal disease, specifically most common in chronic periodontitis.(18,19)

Pathogenesis of Periodontitis

The pathogenesis of periodontitis involves not only microorganisms in plaque, but also several

factors associated with the host. In the early stages of periodontitis, inflammation occurs in

gingiva as a response to bacterial attack. Red complex bacteria will triggers the immune

response, namely neutrophils, macrophages, lymphocytes in the gingival tract, to fight against

periodontal pathogens and endotoxins, maintain the host tissue and control the bacterial

development.(20)

The mechanism of tissue damage occurs through immune response, and is not a direct

consequence of bacteria presences. Macrophages are not the dominant feature in advance lesions,

where they only account for 5% of the cells. Fibroblasts when stimulated by the inflammatory

cytokines IL-1, IL-6, TNF-α, PGE2, will produce Matrix Metalloproteinases (MMPs) which is a

family of proteinases that aims to degrade the extracellular matrix. Collagen molecules are





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broken down into smaller ones, which are then denatured in the extracellular environment or

phagocytosis by surrounding fibroblasts.(20)

Treatment for Periodontitis

Treatment for periodontitis generally falls into two categories: 1) Procedures to stop the

progression of the disease, namely the initial phase therapy consisting of scaling, root planning,

oral hygiene improvement, and occlusal adjustment if needed. 2) Procedures to regenerate

structures damaged by the disease. Supportive maintenance of periodontal therapy after active

treatment is essential to achieve maximum results. Attempts to suppress the sub gingival micro

biota as much as possible, supports the repair and regeneration of the periodontium. In various

short- and long-term clinical studies, the administration of drugs combines with supragingival

plaque control has proven to be effective.(21,22)

Tissue Regeneration

Regeneration is the process of re growing and reconstructing tissue from a lesion, to restore the

initial shape and function of the tissue affected by the lesion. Regeneration oftentimes used to

describe new formation of cementum, adhesions, alveolar bone and periodontal ligamentum on

the surface where the tooth-supporting tissue structure is missing. Regeneration will result in

replacement of the damaged tissue with the same tissue structure. In periodontal tissue, the

damaged epithelium is replaced by epithelium, whereas connective tissue and periodontal

ligaments is replaced by connective tissue.(23)

Virgin Coconut Oil (VCO)

Coconut oil is rich in medium-chain fatty acids and shows good digestibility (Che Man &

Marina, 2006). The term VCO refers to oil obtained from fresh and ripe raw coconut fruit,

mechanically or naturally, with or without the use of heat, and without chemical refining

(Villarino, Dy, & Lizada, 2007). Unlike RBD (Refining, bleaching, and deodorizing) coconut oil

which is specially made for cooking purposes, VCO is currently being marketed as functional

oil. Since it was first introduced, virgin coconut oil has attracted the public attention. Information

about the beneficial properties of VCO spreads rapidly.(24)

Current researches have shown that VCO has the ability to moisturize wounds, accelerate





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cellular metabolism, and has the anti-inflammatory and anti-infection properties in chemical

burns. Virgin coconut oil has been shown to speed up wound healing time and has the highest

percentage of healing effect on chemical burns in Rattus Novergicus. Research conducted on 18

Sprague-Dawley with excision wounds, proved that VCO was able to increase fibroblasts

proliferation so that the density of collagen fibers increased, and helped accelerate the tissue

regeneration process.(5,25)

DISCUSSION

Indonesia is a country with the largest coconut plantation area in the world, reaching 3.7 million

ha. The coconut plant has many benefits from its roots, stems, leaves, fruit, to the midrib. (26)

Virgin Coconut Oil (VCO) is produced from processed coconut flesh which is known to have the

ability to moisturize wounds, accelerate cell metabolism, and has the anti-inflammatory and anti-

infection properties in treatment of chemical burns. VCO has been shown to speed up wound

healing time and has the highest percentage of healing against chemical burns in

Rattusnovergicus. Research conducted on Sprague-Dawley mice with excised wounds proved

that VCO was able to increase fibroblasts proliferation, thus increased the collagen fibers density

and helped accelerate the tissue regeneration process.(27,28)Similar result was also shown in a

study conducted by Ratna Sari et al. (2017) where the number of P. gingivalis and T. denticola

were decreased after gargling with 12.5% VCO for 4 days.(6,8)

Regenerative therapy is a field of biotechnology that combines various aspects and treatment

strategies, including the use of cells produced, in order to increase, restore, or replace a damaged

or missing tissue, effectively repairing the tissue both structurally and functionally. Regenerative

medicine includes the use of growth factors, biomaterials, and stem cells.(29,30) In periodontal

tissue, regeneration is a continuous physiological process, in which under normal conditions new

cells and tissues are constantly being formed to replace mature and dead cells and tissues.(31)

The Medium Chain Triglyceride (MCT) content in VCO in the form of lauric acid,

flavonoids, and tocopherol, is anti-inflammatory and can prevent infection and excessive cell

damage. Lauric acid in VCO is also associated with the activation of TGF-β cytokines which will

stimulate fibronectin in fibrin clots formation, which then become the framework for re-

epithelialization and proliferation of fibroblasts, which can accelerate the healing process in

inflammation.(5) Research conducted by Jansen Silalahi (2019), by applying VCO topically to





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wounds, obtained faster healing as indicated by decreased epithelialization time, increased

fibroblast proliferation, and higher collagen turnover resulted in faster wound healing.(13,25)

Research conducted by Putri Dafriani (2020) on in patients with diabetes mellitus ulcers,

compared the administration of 0.9% NaCL and NaCl combined with VCO, the results then

showed a reduction in wound surface area in the combination group of NaCl and VCO,

Which proved that VCO has an effect on dermal and epidermal healing, and provides strength to

the epithelial tissue.(12,32,33,34,35,36,37)

In a trial done by Dian Ika Perbina Meliala, et al. (2019), the use of Virgin Coconut Oil (VCO)

and VCO hydrolyzed with Rhizomucormiehei (HVCO) resulted in the increased expression of

MMP-9, PDGF BB, and TGF-1β in NIH3T3 cells, suggested that coconut oil is active in the

wound healing process. Whereas in the study conducted by Ummi Aqilah Haron, et al. (2017),

VCO has shown no inhibitory effect on all tested dental caries-related pathogens. Furthermore,

the time killing assay revealed that AVCO showed relatively quick-killing activity at the 8 hours

of time for all tested organism. These finding correlates with that of AVCO possess bactericidal

activity, thereby allowing the possible classification of the AVCO as bactericidal agent.(9,14)

CONCLUSION

Periodontitis can cause damage to both the soft and hard tissues in the oral cavity. VCO is

believed to provide many benefits for daily life, especially in the health sector. Lauric acid,

which is abundant in VCO, can stimulate soft tissue that is damaged due to inflammation.

Further and detailed research is needing regarding the benefits of VCO in healing inflamed

tissue.





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